Washington Highlights: June 24,
2005
House Considers HHS Funding Bill
Contents
Prior Issues
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The House of Representatives June 24 approved the FY 2006 Labor-HHS-Education
Appropriations bill (H.R. 3010). The House adopted the funding levels recommended by the
House Appropriations Committee June 16, including a 0.5 percent
increase for NIH and the elimination of all Title VII health professions
funding except for Centers of Excellence ($12 million) and Scholarships
for Disadvantaged Students ($35 million) [see Washington Highlights,
June 17.]
The House approved an amendment by Rep. Randy Neugebauer (R-Texas)
to cancel funding for two grants supported by the National Institute
of Mental Health. The House approved the proposal as part of block
of amendments adopted by voice vote. One of the targeted grants,
held by a researcher at the University of Iowa, deals with the "perceptual
bases of visual concepts," or the understanding of vision and
perception. The second grant, to a researcher at SUNY-Buffalo, focuses
on "perceived regard and relationship resilience," which
looks at the factors that contribute to successful marriages. In
a written statement, Rep. Neugebauer said his amendment would "save
federal funding for serious mental health research." Rep. Jim
Leach (R-Iowa) spoke on the House floor against the amendment and
urged the chair and ranking member of the subcommittee to address
this issue in the House-Senate conference.
AAMC President Jordan J. Cohen, M.D., joined Association of American
Universities (AAU) President Nils Hasselmo, Ph.D., and National
Association of State Universities and Land-Grant Colleges (NASULGC)
President C. Peter Magrath, Ph.D., in a June 22 letter
to all House members urging them to oppose the Neugebauer amendment.
The letter notes, "By protecting the scientific peer review
system, which subjects research proposals to rigorous review for
scientific and public health merit, Congress ensures that the highest-quality
research-research that contributes directly to public health-is
funded with federal dollars." The letter also states, "
Some in Congress are questioning the value of research into particular
aspects of human or animal behavior. However, the evidence is overwhelming
that such research has been invaluable to our understanding of mental
health and is essential to the prevention, management, and cure
of mental illnesses and disorders."
The Senate Labor-HHS-Education Appropriations Subcommittee is tentatively
scheduled to mark up its version of the FY 2006 funding bill July
12.
Information:
Dave Moore, Senior Director
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
Resident Limit Redistribution Letters Being Sent
Centers for Medicare and Medicaid Services (CMS) staff report that
the agency will be sending letters on June 23 or June 24 to those
teaching hospitals that applied for additional resident limit slots
under the Medicare redistribution program informing them of whether,
and how many, additional resident limit slots they will receive.
The resident cap increases are effective July 1, 2005. Hospitals
that did not apply for additional slots will not be receiving a
letter.
Hospitals will have until Wed., June 29, to respond to CMS regarding
any clerical errors contained within the notification letter the
hospital receives. According to CMS, "clerical errors"
are limited to transcription mistakes that might have been made
by CMS. Unless there is a clerical error, the information contained
in the letters is considered final and is not subject to appeal.
CMS also has provided some information - still to be finalized,
pending any clerical errors - about the slots that will be distributed.
Not all hospitals will receive requested slots, but there will be
enough slots to fill some of the requests from large urban hospitals
- the lowest priority category.
Resident limit applications were assigned to one of six priority
categories, ranging from a rural hospital requesting slots for the
only program in the state (category 1) to large urban hospitals
requesting slots not associated with the only program in the state
(category 6). There was a separate set of evaluation criteria for
use within the priority categories that ranked the applicants within
each category. The evaluation criteria were necessary if not enough
slots were available to satisfy all requests made within a particular
category. There were 15 different criteria under which an applicant
could receive a point, although CMS states that the maximum number
of criteria achieved by applications was "5." Pending
final determinations, CMS will be distributing positions in the
following manner:
Priority Category 1: A rural hospital requesting slots
for the only program in that specialty within the state: will receive
a resident cap increase reflecting all legitimate requests made
under the program for both direct graduate medical education (GME)
and indirect medical education (IME).
Priority Category 2: All other rural hospitals: will
receive a resident cap increase reflecting all legitimate requests
made under the program for both direct GME and IME.
Priority Category 3: A hospital in a small urban area
requesting slots for the only program in that specialty within
the state: will receive a resident cap increase reflecting all
legitimate requests made under the program for both direct GME
and IME.
Priority Category 4: All other hospitals in small urban
areas: will receive a resident cap increase reflecting all legitimate
requests made under the program for both direct GME and IME.
Priority Category 5: A hospital in a large urban area
requesting slots for the only program in that specialty within
the state: will receive a resident cap increase reflecting all
legitimate requests made under the program for both direct GME
and IME.
Priority Category 6: All other large urban hospitals:
- Category 6 with 3, 4 or 5 evaluation points: will receive a
resident cap increase reflecting all legitimate requests made
under the program for both direct GME and IME.
- Category 6 with 2 evaluation points: will receive a resident
cap increase reflecting all legitimate requests made under the
program for direct GME and a prorated share of their legitimate
requests for IME.
- Priority Category 6 with 1 evaluation point: will receive a
prorated share of legitimate requests for direct GME and no increase
for IME.
- Priority Category 6 with 0 evaluation points: will receive no
resident cap increase for either direct GME or IME.
Information:
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Frist, Clinton introduce Health IT Bill
Senate Majority Leader Bill Frist (R-Tenn.) and Senator Hillary
Clinton (D-N.Y.) June 16 introduced S. 1262, "The Health Technology
to Enhance Quality Act of 2005." According to the bill's summary,
it "will help harness the potential of health information technology
(IT) and preserve patient privacy while reducing costs, enhancing
efficiency, and improving the overall quality of patient care."
Specifically, S.
1262 would establish in statute the Office of the National Coordinator
for Health Information Technology (ONCHIT), created by the Bush
administration in 2004. ONCHIT is located within the Department
of Health and Human Services (HHS). The bill directs ONCHIT to work
with the National Institute for Standards and Technology (NIST)
to establish a permanent electronic health information standards
development working group to review existing standards, identify
deficiencies and omissions working against a national goal of interoperability,
and recommend to the HHS Secretary which standards should be adopted.
According to the legislation, ONCHIT would also direct and coordinate
federal spending related to health care IT. The bill authorizes
$125 million per year in grants to local or regional health care
facilities over five years in order to create an interoperable system
in which records could be stored electronically. S.
1252 also provides exemptions from "Stark" self-referral
and anti-kickback laws to allow hospitals, health plans and other
to offer health information technology equipment to physicians as
long as its purpose is to "reduce medical errors, improve quality,
reduce costs, improve care coordination, streamline administration,
and promote competition and transparency." Relief from the
physician self-referral and anti-kickback laws would apply only
if the physician entity receiving support complies with final data
standards for interoperability.
The bill requires the Medicare program to establish a budget neutral
"value-based purchasing pilot program to encourage the reporting
of health care quality data and facilitate the payment of providers
based on performance." The pilot program could be expanded
nationwide and implemented after two years. The bill also includes
a "Sense of the Senate" that Medicare physician payment
modifications should include provisions to encourage the adoption
of health IT standards and reporting of quality measures.
S. 1252 also directs HHS, the Departments of Defense and Veterans
Affairs and other federal agencies to adopt uniform healthcare quality
measures to assess "the effectiveness, timeliness, efficiency,
patient centeredness and safety of care across federal health care
programs" including Medicare, Medicaid and State Children's
Health Insurance Program.
Information:
AAMC Government Relations
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
House Judiciary Panel Passes Legislation Removing
Physician Group Limits on Patients Receiving Substance Abuse Treatment
The House Judiciary Subcommittee on Crime, Terrorism, and Homeland
Security June 23 approved by voice vote AAMC-endorsed
legislation, H.R.
869, removing the current statutory limit on physician group
practices that treat substance abuse patients. The House Energy
and Commerce Committee, which also has jurisdiction over the legislation,
passed the legislation May 4 [see Washington Highlights,
May 6]. H.R. 869 was introduced
by Rep. Mark Souder (R-Ind.) on Feb. 16; the AAMC and 39 provider
and patient groups endorsed the bill in an April 25 letter. Companion
legislation (S.
45) was introduced in the Senate by Senators Carl Levin (D-Mich.),
Orrin Hatch (R-Utah) and Joseph Biden (D-Del.) on Jan. 24.
The 106th Congress enacted the Drug Addiction Treatment Act (DATA)
2000 to expand treatment options for patients addicted to opiates.
A limit of 30 patients per treating physician was included in the
legislation to address concerns about potential abuse or diversion
of the treatment medications. In addition to the limit per physician,
DATA also contained language that imposed a 30-patient cap on group
practices as well as amending the Controlled Substances Act. H.R.
869 clarifies that group practices would not be limited to 30 patients,
while still limiting each provider within the group to 30 patients
seeking treatment for their drug addictions.
Information:
AAMC Government Relations
Subcommittee Hearing Focuses on Medicaid Drug
Costs
The House Energy and Commerce Subcommittee on Health continued
to explore options for Medicaid reform during a June 22 hearing that focused on drug reimbursement policies. Both
the Bush Administration and the National Governors Association (NGA)
have proposed changing the drug reimbursement system as a way to
reduce Medicaid program expenditures.
During the hearing, Congressional Budget Office (CBO) Director
Douglas Holtz-Eakin testified that prescription drug spending grew
by about 15.5 percent annually from 1998 - 2004, and totaled about
$30.6 billion in 2004. He stated that "upward pressure on prescription-drug
spending will continue to pose budgetary challenges for Medicaid,"
despite new Medicare coverage for dually eligible beneficiaries.
In his testimony, Dr. Holtz-Eakin estimated that the Medicaid program
could save approximately $3 billion over five years by increasing
the rebate that drug manufacturers pay the states from 15 to 20
percent.
Information:
Christiane Mitchell, Director, Federal Affairs
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Senate Panel Approves Small Increase for NSF
The Senate Appropriations Committee June 23 approved its version
of the FY 2006 funding bill, providing $5.53 billion for the National
Science Foundation (NSF), an increase of $58 million (1.1 percent)
over the previous year. The Commerce, Justice, Science Appropriations
Subcommittee approved the bill on June 21. The House of Representatives
June 16 approved its version of the bill (H.R.
2862), calling for a 3.1 percent increase for the NSF.
Information:
Jonathan Fishburn, Director, Research, Education and Veterans' Legislative Affairs
AAMC Government Relations
jfishburn@aamc.org
(202) 828-0525
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